Fluoroscopic C2 selective nerve root block enabled with CT angiogram

The anatomy of the vertebral artery (VA) can be variable around the C1 and C2 vertebrae, which can pose risk during cervical spine instrumentation and pain blocks. A patient with prior cerebellar astrocytoma required a C2 nerve root block for treatment of occipital neuralgia. Precise location of the VA was questioned due to previous posterior C1 arch excision.

The objective was to describe the utility of CT angiogram (CTA) in describing VA location in planning the C2 nerve root block. Once determined that the VA was not in proximity of the lateral atlantoaxial joint (LAA), then the C2 nerve block was completed uneventfully with resolution of occipital pain.

The CTA was critical in determining VA location in advance of C2 nerve root block, and can be used with regularity when vascular anatomy is questioned.